This invention relates generally to pharmaceutical management and dispensing systems, and more specifically concerns an automated system for managing the dispensing and inventory of pharmaceuticals or other small medical supplies, the system including patient-specific or drug-specific bin receptacles and related vending carts or cabinets, primarily for use in hospitals, nursing homes and other large medical facilities.
Existing hospitals and other large medical facilities typically include a central pharmacy staffed by trained pharmacists and other personnel who fill, by hand, patient-specific prescriptions ordered by individual doctors for their patients being treated at the facility. The pharmaceuticals dispensed by the pharmacy include a wide range of medications, including prescription and non-prescription (over-the-counter or OTC) medications in individual unit-of-use (single use) packages. A typical hospital pharmacy must stock 1500-2000 separate drugs or other line items, of which, on a typical given day, a total of 300-350 different items might be actually used. Certain medical supplies, such as syringes, inhalers, bandages, IV (intravenous) tubes are typically included in such a system.
This institutional-type pharmaceutical-dispensing system, known generally as a xe2x80x9cUnit Dose Drug Distribution Systemxe2x80x9d, is quite labor-intensive, with each filled medication order comprising individually packaged pills, syringes, patches, etc. in unit-of-use packages. The correct items are hand-picked and placed into each patient""s bin (which is hand-labeled with the patient""s name), before it is transported in multi-bin groups known as cassettes to and from patient care areas (wards) on transport carts for bed-to-bed dose administration to individual patients by a nurse. The mode and timing of transporting the medications and supplies can vary widely, from being hand-carried to and from patient wards on large cassette transport carts, usually once every so many days (anywhere from daily to seven days) for patient-specific bins, or after-hours doses or starter doses by some other delivery system, such as pneumatic tubes (many times per day) which deliver medications to and from wards without a human carrier, or by semi-automatic vending machines which are refilled by hand one to three times daily.
Typically, when the medication cassettes arrive at the ward, such as on a transfer cart, they are exchanged into and out of mobile carts or stationary cabinets, referred to as medication carts, for later use by the nurses. In such a system, each patient has two bins, one in actual use at the nurse""s station (ward) and one being refilled in the pharmacy. In other systems, a single patient bin is labeled and replenished on the ward using a mobile pharmacy cabinet. In nearly every hospital, the patient bins are replenished every one to seven days, with hand-picked/placed patient-specific medication doses.
The carts with the patient bins are usually stored in a medication room at the nursing station in each ward. Typically, the medications are administered by a nurse four times per day. The nurses use a patient profile book to ensure accuracy of medication and administration. The patient profile book is identical to the book used by the pharmacists to fill the patient bins.
The medication carts vary widely in size, arrangement and sophistication, from a very simple cabinet having several shelves for storage of medications for several patients to cabinets having individual bins which are identified according to patient. Typically, medication cabinets are locked and can only be accessed by authorized personnel. In some cases, each individual patient bin or receptacle in the cabinet is individually locked as well.
Such a pharmaceutical system, as indicated above, is heavily labor intensive, particularly for the trained pharmacists, who hand pick and then place the medications in the patient bins, and has a high potential for errors, during the filling of the medication order, during delivery of the medication doses to the ward, and finally during administration of the doses to the patient. The conventional systems are quite slow, taking several hours in some cases to complete a run of medications for an entire hospital, for instance. In addition, the medications already in a patient""s bin may be superseded at any time by new orders from the doctor, which can result in confusion as to proper medications for the patient and/or delays in the administration of desired medications.
While it is generally desirable to have patient medications delivered faster in an institutional setting, such as a hospital, i.e. more often than once per day, existing systems are so laborious that such timely deliveries of medications are virtually impossible. It is also well accepted that it would be most desirable to have correct, up-to-date medications delivered just in time (JIT) before they are to be administered to the patient, typically at 8 AM, 12 Noon, 4 PM and 8 PM (hospital times). Other medications for a patient may be provided on an as-needed basis. In addition, it is desirable to have any change in patient medications ordered by a doctor effective immediately, in time for the next medication time. Again, due to cost and the cumbersomeness of existing systems, such a goal has to date been difficult, if not impossible, to obtain.
There have been a few attempts at automating medication dispensing systems in hospitals, but these have not improved overall delivery time significantly, and further are not integrated into an overall system; hence, errors and inefficiencies in the overall system of medication delivery still occur. Centralized pharmacies, where doctors"" prescription orders are hand-filled by trained pharmacists, are still the overwhelmingly (95%) used system for hospitals and other large medical facilities.
As indicated above, however, a truly automated and complete medication management and dispensing system is highly desirable for hospitals and other large institutional medical facilities. In such a system, a patient""s medication orders will be filled automatically and quickly, and be delivered to the patient ward just before each dosage time. Such a system would also desirably permit the more efficient and more valuable use of pharmacists in a primary role as drug therapy advisers as opposed to filling prescription orders.
Such a system would also correct or significantly improve existing difficulties and inefficiencies in inventory management, permitting appropriate stocking of medications and supplies which move quickly, while not overstocking medications and supplies for which there is little demand. Still further, there is a recognized need and desire in the medical community for an integrated medication management system in which the filling of medication orders and the delivery of those medications to the patient includes multiple safety checks to ensure that the patient receives exactly those medications ordered by the patient""s doctor, in the correct dosage, at the right time, and that the medications are those set out in the most recent, up-to-date order of the doctor.
Accordingly, a first aspect of the present invention is an apparatus for automatically dispensing medical elements to an individual bin receptacle, wherein the bin receptacle has at least one individual sector, comprising: at least one vault storage assembly comprising a plurality of storage members for medical elements, each storage member holding a plurality of overpackaged medical elements; means for ejecting the overpackaged medical elements from their associated storage member, in response to a signal command; means for moving the bin receptacle into a medical element receiving position; means for collecting and transferring the ejected overpackaged medical elements into the bin receptacle; and control means, providing signal commands, for controlling operation of the apparatus.
Another aspect of the present invention is a method for dispensing medical elements for a patient into an individual bin receptacle and subsequent delivery of said bin receptacle to the patient for use of the medical elements, comprising the steps of: receiving selected medical element information for a patient, such as from a hospital computer; transferring said medical information to a medical elements dispensing apparatus; maintaining a selected number of medical elements in the medical elements dispensing apparatus; moving a bin having at least one sector therein into the medical elements dispensing apparatus, wherein each bin is uniquely identified with a patient; automatically obtaining selected medical elements from storage members therefor in the apparatus and moving them into the bin; moving the bin containing the medical elements away from the medical elements dispensing apparatus; moving the bin containing the medical elements to the vicinity of the patient associated with the bin; and correlating the bin and selected medical elements therein with the patient to ensure a match prior to the patient receiving the medical elements.
Another aspect of the system of the present invention is a system for automatically controlling the use of medical elements in a health care facility, comprising: means for storing information concerning prescribed medical elements, including medications, for a plurality of patients at a health care facility; at least one vault storage assembly comprising a plurality of storage members for medical elements, each storage member holding a plurality of packaged medical elements; means for moving an individual bin receptacle for holding medical elements, the bin receptacle having an identifying indicia thereon which is associated with one particular patient, into a medical-dispensing apparatus, said medical-dispensing apparatus including means for dispensing prescribed medical elements into the bin receptacle in accordance with the information from the information-storing means; means for moving the bin receptacle with the prescribed medical elements therein out of the medical-dispensing apparatus; means for delivering said bin receptacle to the vicinity of the patient; means for correlating the identification indicia on the bin with identification indicia on the patient to ensure a match prior to the patient receiving the medical elements; and means for automatically controlling the operation of the vault storage means, the receptacle moving means, and the bin receptacle moving means in accordance with the control program and the information storage means.
A further aspect of the system of the present invention is a medication cart for securing and dispensing medical elements, including medications, comprising: a cart housing; rotatable support means within the housing for at least one stack of medical element bins, each bin being divided into a plurality of sectors; means for indexing and tracking rotation of the bins so that the rotational position of the bins relative to a home position is always known; means for preventing unauthorized access to the interior of the housing of the bins; means for stopping the rotatable support means, after rotational movement thereof has been initiated by an operator, at a rotational position such that a bin is accessible and the housing is open; and means, in response to a command signal, for opening the housing to permit access to the desired bin and any medical elements therein.
Another aspect of the system of the present invention is an overjacket package for unit-of-use medical elements, including medications, such that the medical elements can be conveniently dispensed from an automatic element-dispensing apparatus into individual bin receptacles, comprising: a closed package member having an interior for holding a unit-of-use of selected medical elements; and at least one line of perforations in the package member which extends around a substantial portion of the package member, such that the package member may be readily broken apart along the line of perforations to provide access to the unit-of-use medical element contained therein.